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Tuesday, February 13, 2007

The colossal arrogance of an 'E.R.' junkie

[Any physicians out there can feel free to distribute and/or link to the following cautionary tale]

It likely started the same year I was born with 'Dr. Kildare', and progressed through scores of other shows like 'Marcus Welby, M.D.', 'Quincy', 'St. Elsewhere'...  culminating with sophisticated medical dramas such as 'Chicago Hope', 'E.R.' and the diagnostic equivalent of CSI; 'House'. 

By 'it' I'm not referring to medical entertainment... but rather to a growing suspicion (and arrogance) among the TV-viewing public that we know a thing or two about medicine.

For the record, we don't.

First the troubling stuff:

I was talking on the phone with my dad a couple of evenings ago and he was recounting some innocuous details about his day.  Almost as an afterthought he added:

"Oh, I wanted to tell you about something strange that happened earlier.  Mom had to go over to the hair dresser so I went home to check on the dogs and have a rest.  After only 15 or 20 minutes at home I realized I had forgotten to go pick up the results of a medical test and the doctor's office was going to be closing soon.  So I got up to get ready to go back out. But when I stood up I realized that I was having trouble seeing out of one eye."

Now, I have to stop the story here to explain that my dad is legally blind and has only minimal sight in either eye... and I half-jokingly reminded him of this.

"No", he continued, "I mean it was much worse than usual. It was so bad that as I walked to the doctor's office I couldn't see the dial of my watch, much less the usual landmarks I use to navigate my route.  In fact it was so bad that I had to wait for other people to cross the street or I wouldn't have had any idea when it was safe to cross!"

By now the hair on the back of my neck was starting to stand up as my mind started to collect and catalog all the information I've gleaned from my years as an E.R. junkie.   

As sat in front of my computer listening to him talk, my fingers began feverishly Googling 'stroke symptoms' and the rest of my hair (what little I have) stood up as I saw the list of classic stroke symptoms which included: "blurring or loss of vision in one or both eyes".

At that point I shared my suspicions and told my dad to put the phone on speaker and lay it on the table so both he and mom could hear me.  Then, reading off my computer monitor, I told him to smile and asked my mom if his smile was even on both sides.  (It was.)

Next I told him to stick out his tongue and move it from one side of his mouth to the other, asking my mom if it had traveled evenly to both extremes of his mouth.  (It had.)

The last test I was going to ask him to perform was to say a simple sentence in order to check for slurred speech, but I had been talking with him for almost ten minutes and his diction was crystal clear. 

But my eyes kept going back to that item on my computer screen about 'loss or blurring of vision' and I again shared my fear/amateur diagnosis that he had likely suffered a small stroke and that it was important that he get to a hospital as soon as possible to be evaluated.

Everyone reading this... please take note of this next bit so you are never, ever tempted to do anything this bone-headed.  You see, it was at that exact point in time where I ceased helping and began to make and compound mistake after arrogant mistake. 

There are patterns of behavior between parents and children that never, ever change no matter how old/mature the individuals and relationships become.  Among those patterns is the certainty of all parents that they know better than their children.

My parents immediately began 'pooh-poohing' my suggestion to go to the hospital, insisting that dad's eyesight was almost completely back to normal (at least normal for him, anyway).  Furthermore [they argued], it was late and they were already in their pajamas having a late dinner.

I started to waffle [stupid, stupid, stupid!] and instead of insisting that they call an ambulance (as new immigrants they didn't even know that dialing 101 would summon emergency transportation to the hospital of their choice), I began second guessing myself .  I asked [idiotically] if they were sure his vision was pretty much back to normal, and they insisted that it was.

I then misread a passage on a web site about strokes and heart attacks and told him I would speak with him again before he went to bed, but in the mean time he should take a few baby aspirin [colossally, DANGEROUSLY, stupid!].  In fact, had I not been so rattled I would have read more carefully and noticed that  aspirin was indicated before, and sometimes after strokes... but NEVER DURING!!! 

You see, there are two different kinds of strokes; ischemic, which are caused by blockage of blood vessels in or leading to the brain... and hemorrhagic, which are caused by rupturing of blood vessels in, or near the brain.    If my father had been suffering a hemorrhagic stroke, my arrogant advice would have probably doomed him right there and then.

I reluctantly let them off the phone and promised to speak to dad before bed time. 

As the evening passed I did more 'research' on the web.  But for some reason the more I read indicating that my dad should already have been in the hospital being evaluated... the more I tried to rationalize my having given in to their reluctance to get dressed and call an ambulance. 

By the time bedtime rolled around and I spoke with my dad again, I had fully convinced myself that since his eyesight was completely back to normal that everything was fine. [idiot!]

I let him off the phone after extracting a promise that he would see a doctor the next day. [complete idiot!!!]

In hindsight, no matter how well-intended my advice may have been, it is only through sheer dumb luck that I didn't kill my father through a deadly combination of arrogance, ignorance and confidence in my diagnostic skills!

Over the next couple of days my father did see a several physicians as promised, and although he still has several tests to be performed, the results so far indicate that he probably did, in fact, suffer a 'mini-stroke'.

Trust me when I tell you that there is absolutely no satisfaction in hearing my arrogant amateur diagnosis confirmed by a professional member of the field.  It just makes me sick.  You see I have since read most of the stroke related websites with calmer eyes and better retention.... and first and foremost, I was an an imbecile to have relented over the issue of going to the hospital. 

I was also criminally negligent (if a layman can be guilty of such a thing) for suggesting he take a couple of aspirin and call the doctor in the morning [how idiotically, criminally cliche!]. 

In fact, if I had placed a revolver with 5 loaded chambers against my father's head and pulled the trigger, his odds of survival would have been only slightly worse than with the aspirin I 'prescribed' since statistically roughly 20% of strokes are hemorrhagic... and aspirin's blood thinning properties could have sped this type of stroke towards it's terrible conclusion rather than lessening the symptoms.

What I now know from my reading (and which I have related to both of my parents) is that the biggest risk factor for strokes is HAVING ALREADY SUFFERED ONE! 

I told my parents in no uncertain terms what an idiot I had been for backing down instead of calling the ambulance myself and sending dad to the hospital the other night.  I also told them that now, more than ever, they need to be aware of all possible signs of a stroke. 

I have told my mom to ask their doctor what signs to look for (and write them down) since in some cases my dad might not notice subtle things such a slurring of speech, asymmetrical drooping of facial features, etc.. 

I also told them that in spite of my bumbling, they had dodged a huge bullet the other night.  However, when they decided to pooh-pooh that one, isolated symptom (vision loss) instead of dialing 101, the 'coin' they tossed could have very easily come up 'tails'.  There could be no more such foolishness [they've both agreed].

Now that I know that my dad has no lingering signs of his brush with tragedy and that Israel's wonderful socialized medical system is running an incredible battery of tests and evaluations on him (prodded along with a little gentle help from our modest 'protexia' in the medical community), I can breath just a tiny bit easier. 

But the shame and guilt I feel over the tragedy I almost caused with my arrogant confidence in TV medical knowledge is something that will be with me for a very, very long time to come.

220_84

Posted by David Bogner on February 13, 2007 | Permalink

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If you were a doctor you might have grounds to beat yourself up. But you are not. No point making yourself crazy about something that is outside the scope of your training.

You did what you thought was right and sometimes that has to be enough.

Posted by: Jack | Feb 13, 2007 10:53:23 AM

David,

Thank G-d everything is okay, and stop torturing yourself....you did what you thought was right, and now you know better..thats it.

Also..another thing in common...my dad is Legally blind as well..(or at least he says he is...)

Posted by: Safranit | Feb 13, 2007 11:06:18 AM

You initially gave good advice and gave in only after they argued with you. What's done is done, and thank Goodness, your dad is OK.

Te absolvo in nomine Marcus Welby.

Posted by: Doctor Bean | Feb 13, 2007 4:27:24 PM

I don't know where to begin.

Hmm.

1. Stop beating yourself up. You're not a doctor and are not responsible for the medical advice you do/don't dispense.

2. I know you're going to say that was the point of this post.

3. There is every likelihood that, HAD you been a doctor, or had your father been on the phone with HIS doctor, the advice would have been exactly the same, however

4. The advice to go to the hospital that would have come from an MD would have likely been more related to CYA than sound medical reasoning.

5. I still don't know what your dad had, but "mini-stroke" doesn't mean anything because there's no way to confirm this after the fact.

6. I'm not going to try to dispense medical advice over the internet. That would make ME an idiot.

7. I agree that a little knowledge is a dangerous thing, but no knowledge is probably worse.

8. It's likely that a doctor would have advised aspririn too.

9. The fact that you are his son probably had no bearing on his desire to ignore your advice, however if you are perceived as "over-reacting" sometimes people will use that to justify ignoring you.

Here's something that laymen AND doctors sometimes have trouble comprehending:

People sometimes don't follow advice! And adults are responsible for their own actions. And the best you can do is dispense sound advice and hope people will listen.

On another note, I tried unsuccessfully, both as a doctor and as a son, to get my parents to follow certain courses of action, and in the end it led nowhere but to my own increased guilt and second guessing, and created a lot of animosity in the family.

I know you love your father, but you have to support him in his own decision making.

Posted by: psychotoddler | Feb 13, 2007 4:37:06 PM

Dave
I did have a pt complain about being blind until I asked her to open her eyes.

Posted by: dave | Feb 13, 2007 6:20:31 PM

A very honest post, thank you.

Love your blog.

Posted by: Fitzy | Feb 13, 2007 6:57:45 PM

No harm done. A lesson learned and passed on for the benefit of others.

BTW, law enforcement has to deal with something similar. Due to all the CSI shows, many jurors now expect to see all the tricks shown on CSI: Wherever. That makes it harder for the prosecution and the cops who investigate the cases. It also gives criminals better ideas on how to cover their tracks. Warnings about both of those things are being given during training.

Posted by: K Newman | Feb 13, 2007 7:07:43 PM

I'm with Psychotoddler: I'm from a family chock-full of Drs (specialists, even!) in every direction, yet nobody listens to anybody's advice except for when it suits them- and half the time the diagnoses have been famously "off".

Breathe. You did fine.

Posted by: PP | Feb 13, 2007 7:24:13 PM

What psychotoddler said.

Posted by: wanderer | Feb 13, 2007 9:56:57 PM

I'm also an ER junkie and I comletely know what you mean about the dangers of online diagnosis. Doctors sometimes have to be detectives, but they are usually statisticians. They go with the odds. And it usually works. I'm so suprised that you caught the mini-stroke because your dad didn't have any other symptoms except for the vision thing. And odds are, that's not a stroke. Anyway, I'm with everyone else--don't beat yourself up about it. You can only do the best you can and it's awfully hard to force medical care on somebody--especially stubborn parents. I'm really glad that your dad is ok. Good luck to him with all the tests!

Posted by: Shosh | Feb 13, 2007 10:29:47 PM

...OTOH, had you NOT done all this, perhaps they'd never have gone to the doc at all. So... you did more help than anything.

Posted by: Ezzie | Feb 14, 2007 6:11:09 AM

Thank G-d everything is all right.

What others said, there's no need for you to beat yourself up over this.

But *I* certainly learned more about strokes from reading this post than I've ever known! Thanks! Then again, I might want to check on that info with a physician! ; )

Posted by: Irina | Feb 14, 2007 6:56:04 AM

David,

Actually, being an ER junkie isn't arrogance at all. Telling your father to go to the hospital is not a bad thing...one doesn't have to be a doctor to know that stroke symptoms are still "symptoms"...which even the lay-person can see (though only a doctor can legally "diagnose"

As a MDA EMT, I prefer to err on the side of caution, but at the end of the day, I can't force anyone to do something they don't want to do. Quite often, people refuse MDA treatment and refuse transport to the hospital, and then there's nothing we can do about it.

Just know that you can call 101 (MDA) and have them sent anywhere, not only to your home.

Bisorot Tovot and Briyut Tova.

Posted by: Jameel @ The Muqata | Feb 14, 2007 2:29:25 PM

My father had a stroke eight years ago...a hemorrhagic one and he was in the hospital for three weeks. He has lived with us since that time and had several more "brain events", but has been free of any other episodes for around five years. He's 78. After taking care of him for all this time, I am quite familiar with what a stroke victim goes through. I'm sorry that your father had a stroke, but it sounds like he is recovering well. May he recover fully and never have another episode again.

I completely relate to the parent/child dynamic. The only reason it has changed is because I have eight years of taking care of him and I've had to be more of an advocate, but prior to his original stroke, I wouldn't have known what to look for and if he said he was fine I wouldn't have pushed either. Don't be too hard on yourself.

This is a very good post for others to read so they will make sure to get their loved ones immediate medical attention.

Posted by: Tracey | Feb 14, 2007 5:53:20 PM

I'm with Psychotoddler

Who else is with me?

Come, let us go and take over the world!

Posted by: psychotoddler | Feb 14, 2007 9:07:41 PM

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